Please note: Forms need to be printed, when completed, and returned to Human Resources.
You will be taken to the Portal to sign in for each form.
- Benefit Record/Emergency Contact Form
- Dental Expense Claim Form (Delta Dental)
- EyeMed Out of Network Claim Form
- Health Care FSA, Dependent Care FSA, Health Reimbursement Account Claim Reimbursement Form (Fillable)
- Leave Request Form - Administrator (Fillable)
- Leave Request Form - Staff (Fillable)
- Medical Claim Form For Empire BlueCross BlueShield
- Prescription Drug Reimbursement Form